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Manicardi M, Nocetti L, Brigidi A, Cadioli C, Sgreccia D, Valenti AC, Vitolo M, Arrotti S, Monopoli DE, Sgura F, Rossi R, Guidi G, Boriani G. Anthropometric parameters and radiation doses during percutaneous coronary procedures. Phys Med 2022; 100:164-175. [PMID: 35901630 DOI: 10.1016/j.ejmp.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 05/24/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Body size is a major determinant of patient's dose during percutaneous coronary interventions (PCI). Body mass index, body surface area (BSA), lean body mass and weight are commonly used estimates for body size. We aim to identify which of these measures and which procedural/clinical characteristics can better predict received dose. METHODS Dose area product (DAP, Gycm2), fluoroscopy DAP rate (Gycm2/min), fluoroscopy DAP (Gycm2), cine-angiography DAP (Gycm2), Air Kerma (mGy) were selected as indices of patient radiation dose. Different clinical/procedural variables were analysed in multiple linear regression models with previously mentioned patient radiation dose parameters as end points. The best model for each of them was identified. RESULTS Overall 6623 PCI were analysed, median fluoroscopy DAP rate was 35 [IQR 2.7,4.4] Gycm2, median total DAP was 62.7 [IQR 38.1,107] Gycm2. Among all anthropometric variables, BSA showed the best correlation with all radiation dose parameters considered. Every 1 m2 increment in BSA added 4.861 Gycm2/min (95% CI [4.656, 5.067]) to fluoroscopy DAP rate and 164 Gycm2 (95% CI [145.3, 182.8]) to total DAP. Height and female sex were significantly associated to a reduction in fluoroscopy DAP rate and total DAP. Coronary angioplasty, diabetes, basal creatinine and the number of treated vessels were associated to higher values. CONCLUSIONS Main determinants of patient radiation dose are: BSA, female sex, height and number of treated vessels. In an era of increasing PCI complexity and obesity prevalence, these results can help clinicians tailoring X-ray administration to patient's size.
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Affiliation(s)
- Marcella Manicardi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Luca Nocetti
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Alessio Brigidi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Cecilia Cadioli
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Daria Sgreccia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Anna Chiara Valenti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Salvatore Arrotti
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Daniel Enrique Monopoli
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Fabio Sgura
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Rosario Rossi
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gabriele Guidi
- Medical Physics Unit, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
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Goel S, Casazza R, Pasam RT, Montagna E, Gotesman J, Frankel R, Borgen E, Crooke G, Saunders P, Shani J. Operator Radiation Exposure During Transfemoral Transcatheter Aortic Valve Replacement. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100002. [PMID: 37273470 PMCID: PMC10236896 DOI: 10.1016/j.shj.2022.100002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 08/10/2021] [Accepted: 09/29/2021] [Indexed: 06/06/2023]
Abstract
Background The level of radiation exposure received by operators performing transcatheter aortic valve replacement (TAVR) is not well investigated. The aim of this study is to measure the amount of radiation received by operators performing transfemoral TAVR and to identify various patient and procedural characteristics associated with increased radiation exposure. Methods Primary (operator 1) and secondary (operator 2) operators' equivalent radiation doses in micro Sieverts (µSv) were calculated prospectively using real-time radiation dosimeters for a total of 140 consecutive transfemoral TAVRs. Corresponding eye and thorax radiation exposures between the operators were compared. Associations between various patient and procedural characteristics and the radiation exposure were tested using the t-test and Wilcoxon Mann-Whitney rank-sum test with Monte Carlo estimation. Multivariable regression analysis was also conducted. Results Operator 1 had significantly higher cumulative equivalent radiation exposure than operator 2 (86 µSv vs 38 µSv, p-value: <0.0001) which was consistent at the level of the thorax (67 µSv vs 22 µSv, p-value: <0.0001), but not at the level of the eye (16.5 µSv vs 15 µSv, p-value: 0.30). On multivariable analysis, patient obesity and intraprocedural complications were associated with higher radiation exposure to both operators. Ad hoc percutaneous coronary intervention led to excessive radiation exposure to the secondary operator. Conclusions Transfemoral TAVR is associated with a modest amount of radiation exposure to operators and is significantly higher for the primary operator than for the secondary operator.
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Affiliation(s)
- Sunny Goel
- Department of Cardiology, Mount Sinai Medical Center, New York, New York, USA
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Richard Casazza
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ravi Teja Pasam
- Department of Internal Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
| | - Enrico Montagna
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Joseph Gotesman
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Robert Frankel
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Elliot Borgen
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
| | - Gregory Crooke
- Department of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Paul Saunders
- Department of Cardiothoracic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Jacob Shani
- Department of Cardiology, Maimonides Medical Center, Brooklyn, New York, USA
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Feghali JA, Delépierre J, Belac OC, Dabin J, Deleu M, De Monte F, Dobric M, Gallagher A, Hadid-Beurrier L, Henry P, Hršak H, Kiernan T, Kumar R, Knežević Ž, Maccia C, Majer M, Malchair F, Noble S, Obrad D, Sans Merce M, Sideris G, Simantirakis G, Spaulding C, Tarantini G, Van Ngoc Ty C. Patient exposure dose in interventional cardiology per clinical and technical complexity levels. Part 1: results of the VERIDIC project. Acta Radiol 2021; 64:108-118. [PMID: 34958271 DOI: 10.1177/02841851211061438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients can be exposed to high skin doses during complex interventional cardiology (IC) procedures. PURPOSE To identify which clinical and technical parameters affect patient exposure and peak skin dose (PSD) and to establish dose reference levels (DRL) per clinical complexity level in IC procedures. MATERIAL AND METHODS Validation and Estimation of Radiation skin Dose in Interventional Cardiology (VERIDIC) project analyzed prospectively collected patient data from eight European countries and 12 hospitals where percutaneous coronary intervention (PCI), chronic total occlusion PCI (CTO), and transcatheter aortic valve implantation (TAVI) procedures were performed. A total of 62 clinical complexity parameters and 31 technical parameters were collected, univariate regressions were performed to identify those parameters affecting patient exposure and define DRL accordingly. RESULTS Patient exposure as well as clinical and technical parameters were collected for a total of 534 PCI, 219 CTO, and 209 TAVI. For PCI procedures, body mass index (BMI), number of stents ≥2, and total stent length >28 mm were the most prominent clinical parameters, which increased the PSD value. For CTO, these were total stent length >57 mm, BMI, and previous anterograde or retrograde technique that failed in the same session. For TAVI, these were male sex, BMI, and number of diseased vessels. DRL values for Kerma-area product (PKA), air kerma at patient entrance reference point (Ka,r), fluoroscopy time (FT), and PSD were stratified, respectively, for 14 clinical parameters in PCI, 10 in CTO, and four in TAVI. CONCLUSION Prior knowledge of the key factors influencing the PSD will help optimize patient radiation protection in IC.
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Affiliation(s)
- Joelle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Julie Delépierre
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Olivera Ciraj Belac
- Department of Radiation and Environmental Protection, Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Beograd, Serbia
| | - Jérémie Dabin
- SCK CEN Belgian Nuclear Research Center, Mol, Belgium
| | - Marine Deleu
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Milan Dobric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aoife Gallagher
- Department of Medical Physics, University Hospital Limerick, Limerick, Ireland
| | - Lama Hadid-Beurrier
- Department of Radiation Protection and Medical Physics, Lariboisière University Hospital, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Tom Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Carlo Maccia
- Centre d’Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | | | - Françoise Malchair
- Centre d’Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Marta Sans Merce
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Georgios Sideris
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Christian Spaulding
- Department of Cardiology, European Georges Pompidou University Hospital, Paris, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claire Van Ngoc Ty
- Department of Radiology, European Georges Pompidou Hospital, Paris, France
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Feghali JA, Delépierre J, Belac OC, Dabin J, Deleu M, De Monte F, Dobric M, Gallagher A, Hadid-Beurrier L, Henry P, Hršak H, Kiernan T, Kumar R, Knežević Ž, Maccia C, Majer M, Malchair F, Noble S, Obrad D, Merce MS, Sideris G, Simantirakis G, Spaulding C, Tarantini G, Van Ngoc Ty C. Establishing a priori and a posteriori predictive models to assess patients' peak skin dose in interventional cardiology. Part 2: results of the VERIDIC project. Acta Radiol 2021; 64:125-138. [PMID: 34935520 DOI: 10.1177/02841851211062089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Optimizing patient exposure in interventional cardiology is key to avoid skin injuries. PURPOSE To establish predictive models of peak skin dose (PSD) during percutaneous coronary intervention (PCI), chronic total occlusion percutaneous coronary intervention (CTO), and transcatheter aortic valve implantation (TAVI) procedures. MATERIAL AND METHODS A total of 534 PCI, 219 CTO, and 209 TAVI were collected from 12 hospitals in eight European countries. Independent associations between PSD and clinical and technical dose determinants were examined for those procedures using multivariate statistical analysis. A priori and a posteriori predictive models were built using stepwise multiple linear regressions. A fourfold cross-validation was performed, and models' performance was evaluated using the root mean square error (RMSE), mean absolute percentage error (MAPE), coefficient of determination (R²), and linear correlation coefficient (r). RESULTS Multivariate analysis proved technical parameters to overweight clinical complexity indices with PSD mainly affected by fluoroscopy time, tube voltage, tube current, distance to detector, and tube angulation for PCI. For CTO, these were body mass index, tube voltage, and fluoroscopy contribution. For TAVI, these parameters were sex, fluoroscopy time, tube voltage, and cine acquisitions. When benchmarking the predictive models, the correlation coefficients were r = 0.45 for the a priori model and r = 0.89 for the a posteriori model for PCI. These were 0.44 and 0.67, respectively, for the CTO a priori and a posteriori models, and 0.58 and 0.74, respectively, for the TAVI a priori and a posteriori models. CONCLUSION A priori predictive models can help operators estimate the PSD before performing the intervention while a posteriori models are more accurate estimates and can be useful in the absence of skin dose mapping solutions.
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Affiliation(s)
- Joelle Ann Feghali
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Julie Delépierre
- Department of Radiology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Olivera Ciraj Belac
- Department of Radiation and Environmental Protection, Vinca Institute of Nuclear Sciences-National Institute of the Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Jérémie Dabin
- SCK CEN Belgian Nuclear Research Center, Mol, Belgium
| | - Marine Deleu
- Institute of Radiation Physics, Lausanne University Hospital, Lausanne, Switzerland
| | - Francesca De Monte
- Medical Physics Department, Veneto Institute of Oncology IOV – IRCCS, Padua, Italy
| | - Milan Dobric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aoife Gallagher
- Department of Medical Physics, University Hospital Limerick, Limerick, Ireland
| | - Lama Hadid-Beurrier
- Department of Radiation Protection and Medical Physics, Lariboisière University Hospital, Paris, France
| | - Patrick Henry
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Tom Kiernan
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | - Rajesh Kumar
- Department of Cardiology, University Hospital Limerick, Limerick, Ireland
| | | | - Carlo Maccia
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | | | - Françoise Malchair
- Centre d'Assurance de qualité des Applications Technologiques dans le domaine de la Santé, Sèvres, France
| | - Stéphane Noble
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | - Marta Sans Merce
- Department of Radiology, Geneva University Hospital, Geneva, Switzerland
| | - Georgios Sideris
- Department of Cardiology, Lariboisière University Hospital, Paris, France
| | | | - Christian Spaulding
- Department of Cardiology, European Georges Pompidou University Hospital, Paris, France
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Claire Van Ngoc Ty
- Department of Radiology, European Georges Pompidou Hospital, Paris, France
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5
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Kakkos SK, Efthymiou FO, Metaxas VI, Dimitroukas CP, Panayiotakis GS. Factors affecting radiation exposure in endovascular repair of abdominal aortic aneurysms: a pilot study. INT ANGIOL 2020; 40:125-130. [PMID: 33315209 DOI: 10.23736/s0392-9590.20.04508-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Radiation exposure during endovascular repair (EVAR) of abdominal aortic aneurysms (AAAs) is a potential issue. Several studies have identified factors affecting radiation exposure, although they are limited. The aim of this study was to identify independent factors affecting radiation exposure in patients with AAA undergoing standard EVAR. METHODS Forty-eight consecutive patients underwent elective EVAR for infrarenal AAA managed between April 2019 and April 2020. Fluoroscopy time (FT) and kerma area product (KAP) were the main outcome measures. RESULTS Median (interquartile range) FT and KAP values were 1018 (653-1619) s and 2.68 (2.08-3.81) mGy·m2, respectively. C3 Excluder graft use and main body insertion site from the right femoral were associated with significantly lower FT. Coronary artery disease, endografts with two docking limbs, AAA diameter, neck angle and length, procedure duration, contrast amount, and hospitalization were associated with significantly higher FT. Neck angle was the single independent perioperative factor related to FT higher than the median value observed in the study (P=0.004, odds ratio: 1.073, 95% confidence interval: 1.023-1.126). The use of the C3 Excluder device was associated with lower KAP. AAA diameter, neck angle, procedure duration, contrast medium amount and postoperative hospitalization were associated with higher KAP. AAA diameter was the single independent factor related to KAP higher than the median value observed in the study (P=0.013, odds ratio: 3.73, 95% confidence interval: 1.32-10.56). CONCLUSIONS This study has identified factors affecting radiation exposure during standard EVAR for infrarenal AAAs. These factors should be taken into account when contemplating AAA repair.
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Affiliation(s)
- Stavros K Kakkos
- Department of Vascular Surgery, Medical School, University of Patras, Patras, Greece -
| | - Fotios O Efthymiou
- Department of Medical Physics, Medical School, University of Patras, Patras, Greece
| | - Vasileios I Metaxas
- Department of Medical Physics, Medical School, University of Patras, Patras, Greece
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Patient exposure data and operator dose in coronary interventional procedures: Impact of body-mass index and procedure complexity. Phys Med 2020; 76:38-43. [DOI: 10.1016/j.ejmp.2020.05.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/04/2020] [Accepted: 05/08/2020] [Indexed: 12/13/2022] Open
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Zucca S, Solla I, Boi A, Loi S, Rossi A, Sanna F, Loi B. The role of a commercial radiation dose index monitoring system in establishing local dose reference levels for fluoroscopically guided invasive cardiac procedures. Phys Med 2020; 74:11-18. [PMID: 32388465 DOI: 10.1016/j.ejmp.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 04/15/2020] [Accepted: 04/21/2020] [Indexed: 02/01/2023] Open
Abstract
PURPOSE The primary goal was to evaluate local dose level for fluoroscopically guided invasive cardiac procedures in a high-volume activity catheterization laboratory, using automatic data registration with minimal impact on operator workload. The secondary goal was to highlight the relationship between dose indices and acquisition parameters, in order to establish an effective strategy for protocols optimization. METHODS From September 2016 to December 2018, a dosimetric survey was conducted in the 2 rooms of the catheterization laboratory of our institution. Data collection burden was minimized using a commercial Radiation Dose Index Monitoring System (RDIMs) that analyzes dicom files automatically sent by the x-ray equipment. Data were combined with clinical information extracted from the HIS records reported by the interventional cardiologist. Local dose levels were established for different invasive cardiac procedures. RESULTS A total of 3029 procedures performed for 2615 patients were analyzed. Median KAP were 21 Gycm2 for invasive coronary angiography (ICA) procedures, 61 Gycm2 for percutaneous coronary intervention (PCI) procedures, 59 Gycm2 for combined (ICA+PCI) procedures, 87 Gycm2 for structural heart intervention (TAVI) procedures. A significant dose reduction (51% for ICA procedures and 58% for PCI procedures) was observed when noise reduction acquisition techniques were applied. CONCLUSIONS RDIMs are effective tools in the establishment of local dose level in interventional cardiology, as they mitigate the burden to collect and register extensive dosimetric data and exposure parameters. Systematic review of data support the multi-disciplinary team in the definition of an effective strategy for protocol management and dose optimization.
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Affiliation(s)
- Sergio Zucca
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy.
| | - Ignazio Solla
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Alberto Boi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Stefano Loi
- Medical Physics, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Angelica Rossi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Francesco Sanna
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
| | - Bruno Loi
- Interventional Cardiology, Azienda Ospedaliera Brotzu Cagliari, Italy
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Miller DL. Review of air kerma‐area product, effective dose and dose conversion coefficients for non‐cardiac interventional fluoroscopy procedures. Med Phys 2020; 47:975-982. [DOI: 10.1002/mp.13990] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/09/2019] [Accepted: 12/17/2019] [Indexed: 11/08/2022] Open
Affiliation(s)
- Donald L. Miller
- Center for Devices and Radiological Health U.S. Food and Drug Administration Silver Spring MD 20993USA
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9
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Al-Jabri AJ, Alzimami K, Alsafi K, Alaamer AS, Al-Rajhi MA, Suliman II. RETROSPECTIVE ANALYSIS OF PATIENT RADIATION DOSES IN DIGITAL CORONARY ANGIOGRAPHY AND INTERVENTIONS. RADIATION PROTECTION DOSIMETRY 2019; 183:496-501. [PMID: 30260437 DOI: 10.1093/rpd/ncy168] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/19/2018] [Accepted: 08/30/2018] [Indexed: 06/08/2023]
Abstract
This study sought to assess patient and operator eye lens doses in diagnostic coronary angiography (DCA) and percutaneous coronary interventions (PCI) in a University hospital in Oman. Kerma area product (PkA), cumulative air kerma (CAK) and fluoroscopic time (FT) were retrospectively recorded from the DICOM header for 264 patients. The median (interquartile range) of FT, PKA and CAK were: 5.3 min (2.6-10.5), 60.9 Gy cm2 (41.3-91.4) and 0.86 Gy (0.61-1.29), respectively, for DCA procedures, and they were 20.2 min (13.3-30.1), 174.0 Gy cm2 (113.7-253.3) and 2.6 Gy (1.8-3.9), respectively, for PCI procedures. The results revealed wide variability in patient doses among individual patients. Monitoring and recording patient dose data can be valuable for quality assurance and patient safety purposes. Feedback to the operator may help optimize radiation doses to patients and prompt further action, as needed.
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Affiliation(s)
- Amna J Al-Jabri
- Department of Radiology and Molecular Imaging, Medical Physics Section, College of Medicine & Health Sciences, Sultan Qaboos University, Al-Khod 123, Oman
| | - Khalid Alzimami
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - K Alsafi
- Department of Radiology, Medical Physics Unit, King Abdul Aziz University, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz S Alaamer
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - M A Al-Rajhi
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
| | - I I Suliman
- Al Imam Mohammad Ibn Saud Islamic University (IMSIU), College of Science, Physics Department, Committee on Radiation and Environmental Pollution Protection, Riyadh, Saudi Arabia
- Sudan Atomic Energy Commission, Institute of Nuclear and Radiological Safety, Khartoum, Sudan
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10
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Mujtaba SF, Saghir T, Sial JA, Rizvi NH. Procedural determinants of fluoroscopy time in patients undergoing cardiac catheterization. Pak J Med Sci 2019; 35:166-171. [PMID: 30881417 PMCID: PMC6408651 DOI: 10.12669/pjms.35.1.294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background & Objective Due to increase in number of cardiac catheterization procedures safety concerns is an issue nowadays. Multiple diagnostic modalities use radiations, which also put a patient at higher cumulative radiation exposure. Therefore steps should be taken to minimize radiation exposure during cardiac catheterization. Hence determination of factors which prolong FT will result in better understanding of problem. This retrospective study was undertaken to determine factors responsible for prolong fluoroscopy time in patients undergoing coronary artery catheterization. Methods This retrospective study was conducted at catheterization Laboratory National Institute of Cardiovascular Diseases, Karachi from June 2014 to June 2015. Patients of either gender, aged between 18 to 90 years undergoing cardiac catheterization procedures were included. Radiation exposure time was measured in terms of fluoroscopy time. Results A total of 957 patients were included in this study out of which 731 were of diagnostic Coronary Angiograms (CA) and 226 were of Percutaneous Coronary Intervention (PCI). The mean age of the study participants was 54.12±10.89 years and majority 734(76.6%) were male. Mean fluoroscopy time (FT) in the patients subjected to PCI was 9.61±6.07 minutes while in cases for CA 4.17±4.13 minutes. FT for CA was observed significantly dependent on procedural access, operator's experience, and LV angiogram. While FT for PCI was found dependent on number of stents deployed during the procedure. Conclusion For invasive coronary angiographic procedures radial route increased fluoroscopy time. For percutaneous coronary intervention femoral and radial route fluoroscopy time were not significantly different.
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Affiliation(s)
- Syed Fayaz Mujtaba
- Syed Fayaz Mujtaba, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Tahir Saghir
- Tahir Saghir, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Jawaid Akbar Sial
- Jawaid Akbar Sial, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Nadeem Hassan Rizvi
- Nadeem Hassan Rizvi National Institute of Cardiovascular Diseases, Karachi, Pakistan
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11
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Quan C, Lee SS. Pattern and degree of radiation exposure during endovascular surgery performed using a mobile C-arm or in a hybrid room. Ann Surg Treat Res 2018; 96:131-137. [PMID: 30838185 PMCID: PMC6393411 DOI: 10.4174/astr.2019.96.3.131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 05/16/2018] [Accepted: 06/29/2018] [Indexed: 12/05/2022] Open
Abstract
Purpose A prospective study was conducted to compare radiation exposure to different parts of an endovascular surgeon's body when using a mobile C-arm with that in a hybrid room. Methods Exposure during individual procedures performed on 39 patients with a mobile C-arm and 42 patients in a hybrid room, from July 2016 to December 2016, was evaluated. Results The procedures performed, fluoroscopy time, and dose-area product were not significantly different between groups. The dose-area product per second in the hybrid room group appeared greater than in the C-arm group (4.5 µGym2/sec vs. 3.1 µGym2/sec). In the C-arm group, the peak skin dose on the right neck (1.77 mSv) and shoulder (1.48 mSv) appeared higher than those on their left side (0.32 mSv, 0.53 mSv, respectively) and the counterparts of the hybrid room group (0.88 mSv, 0.20 mSv, respectively). Conclusion The peak skin dose in the hybrid room appeared highest for the lower part of the protective apron. The dose-area product per second seemed to be greater in the hybrid room than when using the C-arm. Thus, attention should be focused on protecting the surgeon's upper body when using the C-arm and the lower body when using the hybrid room.
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Affiliation(s)
- Cheng Quan
- Department of Vascular Surgery, the Second Hospital of Jilin University, Changchun, Jilin, China
| | - Sang Su Lee
- Research Institute for Convergence of Biomedical Science and Technology, Division of Vascular and Endovascular Surgery, Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
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Nef HM, Abdel-Wahab M, Achenbach S, Joner M, Levenson B, Mehilli J, Möllmann H, Thiele H, Zahn R, Zeus T, Elsässer A. Medikamentenfreisetzende Koronarstents/-scaffolds und medikamentenbeschichtete Ballonkatheter. DER KARDIOLOGE 2018. [DOI: 10.1007/s12181-017-0202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Summary of the Italian inter-society recommendations for radiation protection optimization in interventional radiology. LA RADIOLOGIA MEDICA 2018; 123:378-384. [PMID: 29307078 DOI: 10.1007/s11547-017-0849-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/18/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES A Working Group coordinated by the Italian National Institute of Health (Istituto Superiore di Sanità) and the National Workers Compensation Authority (Istituto Nazionale per l'Assicurazione contro gli Infortuni sul Lavoro, INAIL) and consisting of 11 Italian scientific/professional societies involved in the fluoroscopically guided interventional practices has been established to define recommendations for the optimization of patients and staff radiation protection in interventional radiology. A summary of these recommendations is here reported. MATERIALS AND METHODS A multidisciplinary approach was used to establish the Working Group by involving radiologists, interventional radiologists, neuroradiologists, interventional cardiologists, occupational health specialists, medical physicists, radiation protection experts, radiographers and nurses. The Group operated as a "Consensus Conference". Three main topics have been addressed: patient radiation protection (summarized in ten "golden rules"); staff radiation protection (summarized in ten "golden rules"); and education/training of interventional radiology professionals. RESULTS In the "golden rules", practical and operational recommendations were provided to help the professionals in optimizing dose delivered to patients and reducing their own exposure. Operative indications dealt also with continuing education and training, and recommendations on professional accreditation and certification. CONCLUSIONS The "Consensus Conference" was the methodology adopted for the development of these recommendations. Involvement of all professionals is a winning approach to improve practical implementation of the recommendations, thus getting a real impact on the optimization of the interventional radiology practices.
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Ozpelit ME, Ercan E, Ozpelit E, Pekel N, Tengiz I, Ozyurtlu F, Yilmaz A. OPERATOR DEPENDENCY OF THE RADIATION EXPOSURE IN CARDIAC INTERVENTIONS: FEASIBILITY OF ULTRA LOW DOSE LEVELS. RADIATION PROTECTION DOSIMETRY 2017; 173:383-388. [PMID: 26940438 DOI: 10.1093/rpd/ncw028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 01/22/2016] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Mean radiation exposure in invasive cardiology varies greatly between different centres and interventionists. The International Commission on Radiological Protection and the EURATOM Council stipulate that, despite reference values, 'All medical exposure for radiodiagnostic purposes shall be kept as low as reasonably achievable' (ALARA). The purpose of this study is to establish the effects of the routine application of ALARA principles and to determine operator and procedure impact on radiation exposure in interventional cardiology. MATERIALS AND METHODS A total of 240 consecutive cardiac interventional procedures were analysed. Five operators performed the procedures, two of whom were working in accordance with ALARA principles (Group 1 operators) with the remaining three working in a standard manner (Group 2 operators). Radiation exposure levels of these two groups were compared. RESULTS Total fluoroscopy time and the number of radiographic runs were similar between groups. However, dose area product and cumulative dose were significantly lower in Group 1 when compared with Group 2. Radiation levels of Group 1 were far below even the reference levels in the literature, thus representing an ultra-low-dose radiation exposure in interventional cardiology. CONCLUSION By use of simple radiation reducing techniques, ultra-low-dose radiation exposure is feasible in interventional cardiology. Achievability of such levels depends greatly on operator awareness, desire, knowledge and experience of radiation protection.
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Affiliation(s)
| | - Ertugrul Ercan
- Department of Cardiology, Izmir University, Izmir, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Dokuz Eylul University, Izmir, Turkey
| | - Nihat Pekel
- Department of Cardiology, Izmir University, Izmir, Turkey
| | | | - Ferhat Ozyurtlu
- Department of Cardiology, Grand Medical Hospital, Manisa, Turkey
| | - Akar Yilmaz
- Department of Cardiology, Izmir University, Izmir, Turkey
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Ahmed TA, Taha S. Radiation exposure, the forgotten enemy: Toward implementation of national safety program. Egypt Heart J 2017; 69:55-62. [PMID: 29622955 PMCID: PMC5839352 DOI: 10.1016/j.ehj.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 10/08/2016] [Indexed: 01/05/2023] Open
Abstract
Radiation safety is an important counterpart in all facilities utilizing ionizing radiations. The concept of radiation safety has always been a hot topic, especially with the late reports pointing to increased hazards with chronic radiation exposure. Adopting a nationwide radiation safety program is considered one of the most urging topics, and is a conjoint responsibility of multiple disciplines within the health facility.
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Affiliation(s)
- Tarek A.N. Ahmed
- Interventional Cardiology, Department of Cardiovascular Medicine, Asyut University Hospital, Egypt
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Ohlow MA, Farah A, Richter S, El-Garhy M, von Korn H, Lauer B. Comparative Case-Control analysis of a dedicated self-expanding Biolimus A9-eluting Bifurcation stent versus provisional or mandatory side branch intervention strategies in the treatment of coronary bifurcation lesions. Catheter Cardiovasc Interv 2016; 90:39-47. [PMID: 27651317 DOI: 10.1002/ccd.26799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/31/2016] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a number of coronary bifurcation lesions, both the main vessel and the side branch (SB) need stent coverage. OBJECTIVES To analyze the procedural performance and the impact on radiation times (RT) and contrast medium consumption (CMC) of the Axxess™ stent system (Biosensors, Switzerland) treating de novo bifurcation lesions (DBL). METHODS One hundred and ten consecutive prospectively enrolled cases (Axxess Group) and 110 age, sex, and lesion location matched controls undergoing mandatory (Group A, n = 56) or provisional (Group B, n = 54) SB intervention were analyzed. RESULTS Although more pre-dilatation was performed in the Axxess Group (92.7% vs. 46.4% [Group A] vs. 24.1% [Group B]), and more stents were used (2.4 vs. 1.2 vs. 1.05), RT and CMC were significantly lower in the Axxess Group [7.9 min/129 ml vs. 14.2 min/209 ml vs. 7.8 min/152 ml; P < 0.001]. Final Thrombolysis In Myocardial Infarction three flow in both branches was significantly more frequent in the Axxess Group (98.2% vs. 94.6% vs. 88.9%; P = 0.02), and post-interventional troponin T elevations were the lowest in the Axxess Group. Eighty one percent of the Axxess-stents could be implanted without technical difficulties. Difficult implantations procedures were mainly related to coronary anatomy. There was no safety concerns (cardiac death, stent-thrombosis) compared to controls. Cumulative 6-months MACE rates were 11% versus 23% versus 25%. TLR rates at 6-months were 5%, 18%, and 15%, respectively. CONCLUSIONS Axxess bifurcation stent system procedures were associated with significantly less RT and CMC compared to conventional DBL therapy strategies. Difficult coronary anatomy may hinder successful implantation and a learning curve has to be considered. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
| | - Ahmed Farah
- Department of Cardiology, Knappschaftskrankenhaus, Dortmund, Germany
| | - Stefan Richter
- Department of Cardiology, Zentralklinik, Bad Berka, Germany
| | | | | | - Bernward Lauer
- Department of Cardiology, Zentralklinik, Bad Berka, Germany
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Diagnostic reference levels and complexity indices in interventional radiology: a national programme. Eur Radiol 2016; 26:4268-4276. [PMID: 27384609 DOI: 10.1007/s00330-016-4334-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 03/02/2016] [Accepted: 03/14/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVES To propose national diagnostic reference levels (DRLs) for interventional radiology and to evaluate the impact of the procedural complexity on patient doses. METHODS Eight interventional radiology units from Spanish hospitals were involved in this project. The participants agreed to undergo common quality control procedures for X-ray systems. Kerma area product (KAP) was collected from a sample of 1,649 procedures. A consensus document established the criteria to evaluate the complexity of seven types of procedures. DRLs were set as the 3rd quartile of KAP values. RESULTS The KAP (3rd quartile) in Gy cm2 for the procedures included in the survey were: lower extremity arteriography (n = 784) 78; renal arteriography (n = 37) 107; transjugular hepatic biopsies (THB) (n = 30) 45; biliary drainage (BD) (n = 314) 30; uterine fibroid embolization (UFE) (n = 56) 214; colon endoprostheses (CE) (n = 31) 169; hepatic chemoembolization (HC) (n = 269) 303; femoropopliteal revascularization (FR) (n = 62) 119; and iliac stent (n = 66) 170. The complexity involved the increases in the following KAP factors from simple to complex procedures: THB x4; BD x13; UFE x3; CE x3; HC x5; FR x5 and IS x4. CONCLUSIONS The evaluation of the procedure complexity in patient doses will allow the proper use of DRLs for the optimization of interventional radiology. KEY POINTS • National DRLs for interventional procedures have been proposed given level of complexity • For clinical audits, the level of complexity should be taken into account. • An evaluation of the complexity levels of the procedure should be made.
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Sharma D, Ramsewak A, O'Conaire S, Manoharan G, Spence MS. Reducing radiation exposure during transcatheter aortic valve implantation (TAVI). Catheter Cardiovasc Interv 2015; 85:1256-61. [DOI: 10.1002/ccd.25363] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 12/21/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Divyesh Sharma
- Royal Victoria Hospital; Belfast, Northern Ireland United Kingdom
| | - Adesh Ramsewak
- Altnagelvin Hospital; Londonderry Northern Ireland United Kingdom
| | - Sean O'Conaire
- Royal Victoria Hospital; Belfast, Northern Ireland United Kingdom
| | - Ganesh Manoharan
- Royal Victoria Hospital; Belfast, Northern Ireland United Kingdom
| | - Mark S. Spence
- Royal Victoria Hospital; Belfast, Northern Ireland United Kingdom
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HEE LEIA, THOMAS LIZA, ULLAH INAAM, JUERGENS CRAIGP, LO SIDNEY, HOPKINS ANDREW, FRENCH JOHNK, MUSSAP CHRISTIANJ. “Target-Lesion” SYNTAX Score (tSS) Determines Radiation Dose in Percutaneous Coronary Intervention. J Interv Cardiol 2015; 28:157-63. [DOI: 10.1111/joic.12186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- LEIA HEE
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - LIZA THOMAS
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - INAAM ULLAH
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
| | - CRAIG P. JUERGENS
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - SIDNEY LO
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - ANDREW HOPKINS
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - JOHN K. FRENCH
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
| | - CHRISTIAN J. MUSSAP
- Department of Cardiology; Liverpool Hospital; Sydney NSW Australia
- South Western Sydney Clinical School; University of NSW; Sydney NSW Australia
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Comparison of radiation dose exposure in patients undergoing percutaneous coronary intervention vs. peripheral intervention. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:308-13. [PMID: 25489329 PMCID: PMC4252332 DOI: 10.5114/pwki.2014.46776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Revised: 06/15/2014] [Accepted: 09/05/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Most endovascular techniques are associated with patient and personal exposure to radiation during the procedure. Ionising radiation can cause deterministic effects, such as skin injury, as well as stochastic effects, which increase the long-term risk of malignancy. Endovascular operators need to be aware of radiation danger and take all necessary steps to minimise the risk to patients and staff. Some procedures, especially percutaneous peripheral artery revascularisation, are associated with increased radiation dose due to time-consuming operations. There is limited data comparing radiation dose during percutaneous coronary intervention (PCI) with percutaneous transluminal angioplasty (PTA) of peripheral arteries. Aim To compare the radiation dose in percutaneous coronary vs. peripheral interventions in one centre with a uniform system of protection methods. Material and methods A total of 352 patients were included in the study. This included 217 patients undergoing PCI (single and multiple stenting) and 135 patients undergoing PTA (in lower extremities, carotid artery, renal artery, and subclavian artery). Radiation dose, fluoroscopy time, and total procedural time were reviewed. Cumulative radiation dose was measured in gray (Gy) units. Results The total procedural time was significantly higher in PTA (PCI vs. PTA: 60 (45–85) min vs. 75 (50–100) min), p < 0.001. The radiation dose for PCI procedures was significantly higher in comparison to PTA (PCI vs. PTA: 1.36 (0.83–2.23) Gy vs. 0.27 (0.13–0.46) Gy), p < 0.001. There was no significant difference in the fluoroscopy time (PCI vs. PTA: 12.9 (8.2–21.5) min vs. 14.4 (8.0–22.6) min), p = 0.6. The analysis of correlation between radiation dose and fluoroscopy time in PCI and PTA interventions separately shows a strong correlation in PCI group (r = 0.785). However, a weak correlation was found in PTA group (r = 0.317). Conclusions The radiation dose was significantly higher during PCI in comparison to PTA procedures despite comparable fluoroscopy time and longer total procedure time in PTA. Fluoroscopy time is a reliable parameter to control the radiation dose exposure in coronary procedures. The increasing complexity of endovascular interventions has resulted in the increase of radiation dose exposure during PCI procedures.
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Crowhurst JA, Whitby M, Thiele D, Halligan T, Westerink A, Crown S, Milne J. Radiation dose in coronary angiography and intervention: initial results from the establishment of a multi-centre diagnostic reference level in Queensland public hospitals. J Med Radiat Sci 2014; 61:135-41. [PMID: 26229649 PMCID: PMC4175852 DOI: 10.1002/jmrs.67] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 06/05/2014] [Accepted: 07/16/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction Radiation dose to patients undergoing invasive coronary angiography (ICA) is relatively high. Guidelines suggest that a local benchmark or diagnostic reference level (DRL) be established for these procedures. This study sought to create a DRL for ICA procedures in Queensland public hospitals. Methods Data were collected for all Cardiac Catheter Laboratories in Queensland public hospitals. Data were collected for diagnostic coronary angiography (CA) and single-vessel percutaneous intervention (PCI) procedures. Dose area product (PKA), skin surface entrance dose (KAR), fluoroscopy time (FT), and patient height and weight were collected for 3 months. The DRL was set from the 75th percentile of the PKA. Results 2590 patients were included in the CA group where the median FT was 3.5 min (inter-quartile range = 2.3–6.1). Median KAR = 581 mGy (374–876). Median PKA = 3908 uGym2 (2489–5865) DRL = 5865 uGym2. 947 patients were included in the PCI group where median FT was 11.2 min (7.7–17.4). Median KAR = 1501 mGy (928–2224). Median PKA = 8736 uGym2 (5449–12,900) DRL = 12,900 uGym2. Conclusion This study established a benchmark for radiation dose for diagnostic and interventional coronary angiography in Queensland public facilities.
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Affiliation(s)
- James A Crowhurst
- The Prince Charles Hospital Chermside, Queensland, Australia ; School of Medicine, University of Queensland St. Lucia, Brisbane, Queensland, Australia
| | - Mark Whitby
- The Prince Charles Hospital Chermside, Queensland, Australia ; Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - David Thiele
- Biomedical Technology Services, Health Services Support Agency, Queensland Health Herston, Queensland, Australia
| | - Toni Halligan
- Allied Health Professions' Office of Queensland Brisbane, Queensland, Australia
| | - Adam Westerink
- Royal Brisbane and Women's Hospital Herston, Queensland, Australia
| | - Suzanne Crown
- Princess Alexandra Hospital Woolloongabba, Queensland, Australia
| | - Jillian Milne
- Cardiac Clinical Informatics Unit - Queensland Health Herston, Queensland, Australia
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Pyne CT, Gadey G, Jeon C, Piemonte T, Waxman S, Resnic F. Effect of Reduction of the Pulse Rates of Fluoroscopy and CINE-Acquisition on X-Ray Dose and Angiographic Image Quality During Invasive Cardiovascular Procedures. Circ Cardiovasc Interv 2014; 7:441-6. [DOI: 10.1161/circinterventions.114.001479] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Christopher T. Pyne
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Gautam Gadey
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Cathy Jeon
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Thomas Piemonte
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Sergio Waxman
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
| | - Frederic Resnic
- From the Department of Cardiology, Lahey Clinic Medical Center, Burlington, MA
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Michael TT, Karmpaliotis D, Brilakis ES, Alomar M, Abdullah SM, Kirkland BL, Mishoe KL, Lembo N, Kalynych A, Carlson H, Banerjee S, Luna M, Lombardi W, Kandzari DE. Temporal trends of fluoroscopy time and contrast utilization in coronary chronic total occlusion revascularization: insights from a multicenter United States registry. Catheter Cardiovasc Interv 2014; 85:393-9. [PMID: 24407867 DOI: 10.1002/ccd.25359] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Revised: 10/28/2013] [Accepted: 12/23/2013] [Indexed: 11/09/2022]
Abstract
BACKGROUND The impact of operator experience on fluoroscopy time and contrast utilization during percutaneous coronary intervention (PCI) of coronary chronic total occlusions (CTOs) has received limited study. METHODS We evaluated temporal trends in fluoroscopy time and contrast utilization among 1,363 consecutive CTO PCIs performed at three US institutions between January 2006 and November 2011. RESULTS Mean age was 65 ± 11 years, 85% of patients were men, 40% had diabetes, 37% had prior coronary artery bypass graft surgery, and 42% had prior PCI. The CTO target vessel was the right coronary artery (55%), circumflex (23%), left anterior descending artery (21%), and left main or bypass graft (1%). The retrograde approach was used in 34% of all procedures. The technical and procedural success rates were 85.5 and 84.2%, respectively. The mean procedural time, fluoroscopy time, and contrast utilization were 113 ± 61 min, 42 ± 29 min, and 294 ± 158 mL, respectively. Years since initiation of CTO PCI were independently associated with higher technical success rate (odds ratio [OR] = 1.52, 95% confidence interval [CI] = 1.52-1.70, P < 0.001), lower fluoroscopy time (OR = 0.84, 95% CI = 0.75-0.95, P = 0.005), and contrast utilization (OR = 0.84, 95% CI = 0.62-0.79, P < 0.001) during the study period. CONCLUSIONS Among selected US-based institutions performing CTO PCI, we observed a significant reduction in total fluoroscopy time and contrast utilization paralleled with an improved technical success rate over time.
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Affiliation(s)
- Tesfaldet T Michael
- Division of Cardiovascular Diseases, Oregon University Health & Science University, Portland, Oregon
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Vañó Carruana E, Fernández Soto JM, Sánchez Casanueva RM, Ten Morón JI. [Diagnostic reference levels in interventional radiology]. RADIOLOGIA 2013; 55 Suppl 2:17-24. [PMID: 24211195 DOI: 10.1016/j.rx.2013.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 08/07/2013] [Accepted: 08/21/2013] [Indexed: 11/25/2022]
Abstract
This article discusses the diagnostic reference levels for radiation exposure proposed by the International Commission on Radiological Protection (ICRP) to facilitate the application of the optimization criteria in diagnostic imaging and interventional procedures. These levels are normally established as the third quartile of the dose distributions to patients in an ample sample of centers and are supposed to be representative of good practice regarding patient exposure. In determining these levels, it is important to evaluate image quality as well to ensure that it is sufficient for diagnostic purposes. When the values for the dose received by patients are systematically higher or much lower than the reference levels, an investigation should determine whether corrective measures need to be applied. The European and Spanish regulations require the use of these reference values in quality assurance programs. For interventional procedures, the dose area product (or kerma area product) values are usually used as reference values together with the time under fluoroscopy and the total number of images acquired. The most modern imaging devices allow the value of the accumulated dose at the entrance to the patient to be calculated to optimize the distribution of the dose on the skin. The ICRP recommends that the complexity of interventional procedures be taken into account when establishing reference levels. In the future, diagnostic imaging departments will have automatic systems to manage patient dosimetric data; these systems will enable continuous dosage auditing and alerts about individual procedures that might involve doses several times above the reference values. This article also discusses aspects that need to be clarified to take better advantage of the reference levels in interventional procedures.
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Affiliation(s)
- E Vañó Carruana
- Departamento de Radiología, Facultad de Medicina, Universidad Complutense, Madrid, España; Servicio de Física Médica, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - J M Fernández Soto
- Departamento de Radiología, Facultad de Medicina, Universidad Complutense, Madrid, España; Servicio de Física Médica, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - R M Sánchez Casanueva
- Servicio de Física Médica, Hospital Clínico San Carlos, Madrid, España; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J I Ten Morón
- Departamento de Radiología, Facultad de Medicina, Universidad Complutense, Madrid, España; Instituto de Investigación Sanitaria, Hospital Clínico San Carlos (IdISSC), Madrid, España; Servicio de Radiodiagnóstico, Hospital Clínico San Carlos, Madrid, España
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Physicians' Radiation Exposure in the Catheterization Lab. JACC Cardiovasc Interv 2013; 6:1095-102. [DOI: 10.1016/j.jcin.2013.05.012] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 04/26/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022]
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Radiation-induced noncancer risks in interventional cardiology: optimisation of procedures and staff and patient dose reduction. BIOMED RESEARCH INTERNATIONAL 2013; 2013:976962. [PMID: 24027768 PMCID: PMC3762166 DOI: 10.1155/2013/976962] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 06/28/2013] [Accepted: 07/18/2013] [Indexed: 12/18/2022]
Abstract
Concerns about ionizing radiation during interventional cardiology have been increased in recent years as a result of rapid growth in interventional procedure volumes and the high radiation doses associated with some procedures. Noncancer radiation risks to cardiologists and medical staff in terms of radiation-induced cataracts and skin injuries for patients appear clear potential consequences of interventional cardiology procedures, while radiation-induced potential risk of developing cardiovascular effects remains less clear. This paper provides an overview of the evidence-based reviews of concerns about noncancer risks of radiation exposure in interventional cardiology. Strategies commonly undertaken to reduce radiation doses to both medical staff and patients during interventional cardiology procedures are discussed; optimisation of interventional cardiology procedures is highlighted.
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Cousins C, Miller DL, Bernardi G, Rehani MM, Schofield P, Vañó E, Einstein AJ, Geiger B, Heintz P, Padovani R, Sim KH. ICRP PUBLICATION 120: Radiological protection in cardiology. Ann ICRP 2013; 42:1-125. [PMID: 23141687 DOI: 10.1016/j.icrp.2012.09.001] [Citation(s) in RCA: 234] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Cardiac nuclear medicine, cardiac computed tomography (CT), interventional cardiology procedures, and electrophysiology procedures are increasing in number and account for an important share of patient radiation exposure in medicine. Complex percutaneous coronary interventions and cardiac electrophysiology procedures are associated with high radiation doses. These procedures can result in patient skin doses that are high enough to cause radiation injury and an increased risk of cancer. Treatment of congenital heart disease in children is of particular concern. Additionally, staff(1) in cardiac catheterisation laboratories may receive high doses of radiation if radiological protection tools are not used properly. The Commission provided recommendations for radiological protection during fluoroscopically guided interventions in Publication 85, for radiological protection in CT in Publications 87 and 102, and for training in radiological protection in Publication 113 (ICRP, 2000b,c, 2007a, 2009). This report is focused specifically on cardiology, and brings together information relevant to cardiology from the Commission's published documents. There is emphasis on those imaging procedures and interventions specific to cardiology. The material and recommendations in the current document have been updated to reflect the most recent recommendations of the Commission. This report provides guidance to assist the cardiologist with justification procedures and optimisation of protection in cardiac CT studies, cardiac nuclear medicine studies, and fluoroscopically guided cardiac interventions. It includes discussions of the biological effects of radiation, principles of radiological protection, protection of staff during fluoroscopically guided interventions, radiological protection training, and establishment of a quality assurance programme for cardiac imaging and intervention. As tissue injury, principally skin injury, is a risk for fluoroscopically guided interventions, particular attention is devoted to clinical examples of radiation-related skin injuries from cardiac interventions, methods to reduce patient radiation dose, training recommendations, and quality assurance programmes for interventional fluoroscopy.
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Miller DL, Hilohi CM, Spelic DC. Patient radiation doses in interventional cardiology in the U.S.: advisory data sets and possible initial values for U.S. reference levels. Med Phys 2012; 39:6276-86. [PMID: 23039663 DOI: 10.1118/1.4754300] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To determine patient radiation doses from interventional cardiology procedures in the U.S and to suggest possible initial values for U.S. benchmarks for patient radiation dose from selected interventional cardiology procedures [fluoroscopically guided diagnostic cardiac catheterization and percutaneous coronary intervention (PCI)]. METHODS Patient radiation dose metrics were derived from analysis of data from the 2008 to 2009 Nationwide Evaluation of X-ray Trends (NEXT) survey of cardiac catheterization. This analysis used identified data and did not require review by an IRB. Data from 171 facilities in 30 states were analyzed. The distributions (percentiles) of radiation dose metrics were determined for diagnostic cardiac catheterizations, PCI, and combined diagnostic and PCI procedures. Confidence intervals for these dose distributions were determined using bootstrap resampling. RESULTS Percentile distributions (advisory data sets) and possible preliminary U.S. reference levels (based on the 75th percentile of the dose distributions) are provided for cumulative air kerma at the reference point (K(a,r)), cumulative air kerma-area product (P(KA)), fluoroscopy time, and number of cine runs. Dose distributions are sufficiently detailed to permit dose audits as described in National Council on Radiation Protection and Measurements Report No. 168. Fluoroscopy times are consistent with those observed in European studies, but P(KA) is higher in the U.S. CONCLUSIONS Sufficient data exist to suggest possible initial benchmarks for patient radiation dose for certain interventional cardiology procedures in the U.S. Our data suggest that patient radiation dose in these procedures is not optimized in U.S. practice.
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Affiliation(s)
- Donald L Miller
- Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993, USA.
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Delichas MG, Psarrakos K, Hatziioannou K, Giannoglou G, Molyvda-Athanasopoulou E, Papanastassiou E, Sioundas A. The dependence of patient dose on factors relating to the technique and complexity of Interventional Cardiology procedures. Phys Med 2012; 21:153-7. [PMID: 18348858 DOI: 10.1016/s1120-1797(05)80004-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 09/22/2005] [Accepted: 12/21/2005] [Indexed: 11/18/2022] Open
Abstract
Dose-area product (DAP) measurements were conducted for 168 coronary angiography (CA) and 89 single vessel percutaneous transluminal coronary angioplasty (PTCA) to examine the factors influencing patient dose beyond the X-ray exposure parameters. It was found that for CA, the DAP increases with the number of catheters used and with the number of vessels with stenosis. DAP values for patients with a prior bypass surgery, were higher compared to those without such a medical record to surgery. In PTCA, the use of coronary stents did not enhance the patient radiation dose significantly. Noticeable differences were found in the percentage contribution of each projection to the total DAP between the three types of single vessel PTCA. Finally low variations in DAP were found among the cardiologists performing both procedures.
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Affiliation(s)
- Miltiadis G Delichas
- Medical Physics Department, Medical School, Aristotle University of Thessaloniki, Thessaloniki GR 54006 (Greece)
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Journy N, Sinno-Tellier S, Maccia C, Le Tertre A, Pirard P, Pagès P, Eilstein D, Donadieu J, Bar O. Main clinical, therapeutic and technical factors related to patient's maximum skin dose in interventional cardiology procedures. Br J Radiol 2012; 85:433-42. [PMID: 22457404 PMCID: PMC3486680 DOI: 10.1259/bjr/30010948] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The study aimed to characterise the factors related to the X-ray dose delivered to the patient's skin during interventional cardiology procedures. METHODS We studied 177 coronary angiographies (CAs) and/or percutaneous transluminal coronary angioplasties (PTCAs) carried out in a French clinic on the same radiography table. The clinical and therapeutic characteristics, and the technical parameters of the procedures, were collected. The dose area product (DAP) and the maximum skin dose (MSD) were measured by an ionisation chamber (Diamentor; Philips, Amsterdam, The Netherlands) and radiosensitive film (Gafchromic; International Specialty Products Advanced Materials Group, Wayne, NJ). Multivariate analyses were used to assess the effects of the factors of interest on dose. RESULTS The mean MSD and DAP were respectively 389 mGy and 65 Gy cm(-2) for CAs, and 916 mGy and 69 Gy cm(-2) for PTCAs. For 8% of the procedures, the MSD exceeded 2 Gy. Although a linear relationship between the MSD and the DAP was observed for CAs (r=0.93), a simple extrapolation of such a model to PTCAs would lead to an inadequate assessment of the risk, especially for the highest dose values. For PTCAs, the body mass index, the therapeutic complexity, the fluoroscopy time and the number of cine frames were independent explanatory factors of the MSD, whoever the practitioner was. Moreover, the effect of technical factors such as collimation, cinematography settings and X-ray tube orientations on the DAP was shown. CONCLUSION Optimising the technical options for interventional procedures and training staff on radiation protection might notably reduce the dose and ultimately avoid patient skin lesions.
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Affiliation(s)
- N Journy
- Institut de Veille Sanitaire, Saint-Maurice, France.
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31
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ABDEL-WAHAB MOHAMED, NIENABER CHRISTOPHA, MOSTAFA AHMADE, FERENC MIROSLAW, SILBER SIGMUND, SABIN GEORG, TEBBE ULRICH, AKIN IBRAHIM, HOCHADEL MATTHIAS, SENGES JOCHEN, KUCK KARLHEINZ, RICHARDT GERT. Treatment of Coronary Bifurcation Lesions with Drug-Eluting Stents: Insights from the First Phase of the Prospective Multicenter German Drug-Eluting Stent Registry. J Interv Cardiol 2012; 25:344-52. [DOI: 10.1111/j.1540-8183.2011.00718.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Fetterly KA, Lennon RJ, Bell MR, Holmes DR, Rihal CS. Clinical determinants of radiation dose in percutaneous coronary interventional procedures: influence of patient size, procedure complexity, and performing physician. JACC Cardiovasc Interv 2011; 4:336-43. [PMID: 21435613 DOI: 10.1016/j.jcin.2010.10.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 09/28/2010] [Accepted: 10/01/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The objectives of this work were to establish the primary clinical determinants of patient radiation dose associated with percutaneous coronary interventional (PCI) and to identify opportunities for dose reduction. BACKGROUND Use of X-ray imaging and associated radiation dose is a necessary part of PCI. Potential adverse consequences of radiation dose include skin radiation injury and predicted increase in lifetime cancer risk. METHODS Cumulative skin dose (CSD) (measured in gray [Gy] units) was selected as a measurement of patient radiation burden. Several patient-, disease-, and treatment-related variables, including 15 performing physicians, were analyzed in a multiple linear regression statistical model with cumulative skin dose CSD as the primary end point. The model results provide an estimate of the relative CSD increase (decrease) attributable to each variable. RESULTS Percutaneous coronary interventions performed on 1,287 male and 540 female patients were included. Median patient age was 68.6 years, median body mass index was 29.7 kg/m(2), and median weight was 88 kg. Median CSD was 1.64 Gy per procedure for male and 1.15 Gy for female patients. Increasing body mass index, patient sex, lesion complexity, lesion location, and performing physician were significantly associated with CSD. Physicians who performed more procedures were associated with lower CSD. CONCLUSIONS Several primary determinants of patient radiation dose during PCI were identified. Along with physician development of radiation-sparing methods and skills, pre-procedure dose planning is proposed to help minimize radiation dose for PCI.
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Affiliation(s)
- Kenneth A Fetterly
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
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Sciahbasi A, Romagnoli E, Trani C, Burzotta F, Sarandrea A, Summaria F, Patrizi R, Rao S, Lioy E. Operator Radiation Exposure During Percutaneous Coronary Procedures Through the Left or Right Radial Approach. Circ Cardiovasc Interv 2011; 4:226-31. [DOI: 10.1161/circinterventions.111.961185] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Transradial percutaneous coronary procedures may be effectively performed through the right radial approach (RRA) or the left radial approach (LRA), but data on radiation dose absorbed by operators comparing the two approaches are lacking. The aim of the present study was to evaluate radiation dose absorbed by operators during coronary procedures through the RRA and LRA.
Methods and Results—
Three operators were equipped with 5 different dosimeters (left wrist, shoulder, thorax outside the lead apron, thorax under the lead apron, and thyroid) during RRA or LRA for coronary procedures. Each month, the dosimeters were analyzed to determine the radiation dose absorbed. From February to December 2009, 390 patients were randomly assigned to the RRA (185 patients; age, 66±11 years) or the LRA (185 patients; age, 66±11 years). There were no significant differences in fluoroscopy time (for RRA, 369 seconds; interquartile range, 134 to 857 seconds; for LRA, 362 seconds; interquartile range, 142 to 885 seconds;
P
=0.58) between the 2 groups. There were no significant differences in monthly radiation dose at the thorax (0.85±0.46 mSv for RRA and 1.12±0.78 mSv for LRA,
P
=0.33), at the thyroid (0.36±0.2 mSv for RRA and 0.34±0.3 mSv for LRA,
P
=0.87), and at the shoulder (0.73±0.44 mSv for RRA and 0.94±0.42 mSv for LRA,
P
=0.27). The dose at the wrist was significantly higher for the RRA (2.44±1.12 mSv) compared with the LRA (1±0.8 mSv,
P
=0.002). In both radial approaches, the thoracic radiation dose under the lead apron was undetectable.
Conclusions—
Compared with RRA, LRA for coronary procedures is associated with similar radiation dose for operators at the body, shoulder, or thyroid level, with a possible significant advantage at the wrist. The cumulative radiation dose for both approaches is well under to the annual dose-equivalent limit.
Clinical Trial Registration—
URL:
http://www.clinicaltrials.gov
. Unique identifier: NCT00282646.
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Affiliation(s)
- Alessandro Sciahbasi
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Enrico Romagnoli
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Carlo Trani
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Francesco Burzotta
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Alessandro Sarandrea
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Francesco Summaria
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Roberto Patrizi
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Sunil Rao
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
| | - Ernesto Lioy
- From the Cardiology Department, Policlinico Casilino–ASL RM B, Rome, Italy (A. Sciahbasi, E.R., A. Sarandrea, F.S., R.P., E.L.); Catholic University of Sacred Heart, Rome, Italy (C.T., F.B.); and Duke University Medical Center, Durham VA Medical Center, Durham, NC (S.R.)
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Best PJM, Skelding KA, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail GW, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner BH. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Heart Lung Circ 2011; 20:83-90. [PMID: 21241961 DOI: 10.1016/j.hlc.2010.11.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Concerns regarding radiation exposure and its effects during pregnancy are often quoted as an important barrier preventing many women from pursuing a career in Interventional Cardiology. Finding the true risk of radiation exposure from performing cardiac catheterisation procedures can be challenging and guidelines for pregnancy exposure have been inadequate. The Women in Innovations group of Cardiologists with endorsement of the Society for Cardiovascular Angiography and Interventions aim to provide guidance in this publication by describing the risk of radiation exposure to pregnant physicians and cardiac catheterisation personnel, to educate on appropriate radiation monitoring and to encourage mechanisms to reduce radiation exposure. Current data do not suggest a significant increased risk to the foetus of pregnant women in the cardiac catheterisation laboratory and thus do not justify precluding pregnant physicians from performing procedures in the cardiac catheterisation laboratory. However, radiation exposure amongst pregnant physicians should be properly monitored and adequate radiation safety measures are still warranted.
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Affiliation(s)
- Patricia J M Best
- Department of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
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35
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Baiter S, Rosenstein M, Miller DL, Schueler B, Spelic D. Patient radiation dose audits for fluoroscopically guided interventional procedures. Med Phys 2011; 38:1611-8. [PMID: 21520873 PMCID: PMC3064683 DOI: 10.1118/1.3557868] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Revised: 01/20/2011] [Accepted: 01/31/2011] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Quality management for any use of medical x-ray imaging should include monitoring of radiation dose. Fluoroscopically guided interventional (FGI) procedures are inherently clinically variable and have the potential for inducing deterministic injuries in patients. The use of a conventional diagnostic reference level is not appropriate for FGI procedures. A similar but more detailed quality process for management of radiation dose in FGI procedures is described. METHODS A method that takes into account both the inherent variability of FGI procedures and the risk of deterministic injuries from these procedures is suggested. The substantial radiation dose level (SRDL) is an absolute action level (with regard to patient follow-up) below which skin injury is highly unlikely and above which skin injury is possible. The quality process for FGI procedures collects data from all instances of a given procedure from a number of facilities into an advisory data set (ADS). An individual facility collects a facility data set (FDS) comprised of all instances of the same procedure at that facility. The individual FDS is then compared to the multifacility ADS with regard to the overall shape of the dose distributions and the percent of instances in both the ADS and the FDS that exceed the SRDL. RESULTS Samples of an ADS and FDS for percutaneous coronary intervention, using the dose metric of reference air kerma (K(a,r)) (i.e., the cumulative air kerma at the reference point), are used to illustrate the proposed quality process for FGI procedures. Investigation is warranted whenever the FDS is noticeably different from the ADS for the specific FGI procedure and particularly in two circumstances: (1) When the facility's local median K(a,r) exceeds the 75th percentile of the ADS and (2) when the percent of instances where K(a,r) exceeds the facility-selected SRDL is greater for the FDS than for the ADS. CONCLUSIONS Analysis of the two data sets (ADS and FDS) and of the percent of instances that exceed the SRDL provides a means for the facility to better manage radiation dose (and therefore both deterministic and stochastic radiation risk) to the patient during FGI procedures.
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Affiliation(s)
- Stephen Baiter
- Department of Radiology, Columbia University, New York, New York 10032, USA.
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Best P, Skelding K, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail G, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner B. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. EUROINTERVENTION 2011; 6:866-74. [DOI: 10.4244/eijv6i7a148] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Best PJM, Skelding KA, Mehran R, Chieffo A, Kunadian V, Madan M, Mikhail GW, Mauri F, Takahashi S, Honye J, Hernández-Antolín R, Weiner BH. SCAI consensus document on occupational radiation exposure to the pregnant cardiologist and technical personnel. Catheter Cardiovasc Interv 2011; 77:232-41. [DOI: 10.1002/ccd.22877] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/14/2010] [Indexed: 11/05/2022]
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38
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E. Chambers C, A. Fetterly K, Holzer R, Paul Lin PJ, C. Blankenship J, Balter S, K. Laskey W. Radiation safety program for the cardiac catheterization laboratory. Catheter Cardiovasc Interv 2011; 77:546-56. [DOI: 10.1002/ccd.22867] [Citation(s) in RCA: 224] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 09/28/2010] [Accepted: 10/06/2010] [Indexed: 11/11/2022]
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39
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Zhou W. Radiation exposure of vascular surgery patients beyond endovascular procedures. J Vasc Surg 2011; 53:39S-43S. [DOI: 10.1016/j.jvs.2010.06.176] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2010] [Revised: 05/24/2010] [Accepted: 06/11/2010] [Indexed: 11/17/2022]
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Mercuri M, Xie C, Levy M, Valettas N, Natarajan MK. Predictors of increased radiation dose during percutaneous coronary intervention. Am J Cardiol 2009; 104:1241-4. [PMID: 19840569 DOI: 10.1016/j.amjcard.2009.06.037] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 06/11/2009] [Accepted: 06/11/2009] [Indexed: 11/18/2022]
Abstract
Radiation-induced injury is a potential unintended outcome of fluoroscopy-supported cardiology procedures (e.g., percutaneous coronary intervention [PCI]). The injury might be deterministic in nature. Air kerma (AK) is considered an indicator of skin dose, and thus, an indicator for deterministic effects. Few studies have investigated the factors that contribute to an increased radiation dose, and none have used AK as a dependent variable. We studied the registry data of 967 consecutive patients (derivation model) undergoing ad hoc PCI. Linear and multiple regression analyses were performed to investigate which clinical, technical, and anatomic factors were associated with an increased AK. Multiple regression analyses were performed on an additional sample of 1,082 consecutive patients (validation model) to confirm the results. The variables found significant (multiple regression analyses) were radial access (mean increase in AK 253 mGy, 95% confidence interval [CI] 104 to 418, p = 0.0006), number of lesions treated (547 mGy, 95% CI 332 to 789, p < 0.0001), Type C lesions (132 mGy, 95% CI, 26 to 246, p = 0.014), bifurcation lesions (280 mGy, 95% CI 104 to 477, p = 0.0013), and chronic total occlusions (453 mGy, 95% CI 76 to 923, p = 0.016). The validation model (n = 1,082) confirmed all but type C lesions (p = 0.065). In conclusion, the present study has described factors that might contribute to an increased AK during PCI. In revealing a priori known factors associated with an increased radiation dose during PCI, physicians and patients might be more able to evaluate the risks and benefits of such a procedure.
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Affiliation(s)
- Mathew Mercuri
- Heart Investigation Unit, Hamilton Health Sciences, Hamilton, Ontario, Canada.
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41
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Routledge H, Lefèvre T, Colombo A, Oldroyd K, Hamm C, Guagliumi G, von Scheidt W, Guetta V, Ruzyllo W, Wittebols K, Goedhart D, Serruys P. Three-year clinical outcome of percutaneous treatment of bifurcation lesions in multivessel coronary artery disease with the sirolimus-eluting stent: insights from the Arterial Revascularisation Therapies Study, part II (ARTS II). EUROINTERVENTION 2009; 5:190-6. [DOI: 10.4244/eijv5i2a30] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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42
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Kim KP, Miller DL. Minimising radiation exposure to physicians performing fluoroscopically guided cardiac catheterisation procedures: a review. RADIATION PROTECTION DOSIMETRY 2009; 133:227-233. [PMID: 19329511 PMCID: PMC2902901 DOI: 10.1093/rpd/ncp052] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2008] [Revised: 02/23/2009] [Accepted: 03/05/2009] [Indexed: 05/27/2023]
Abstract
What is known about radiation exposure to physicians who perform cardiac interventions is reviewed and various factors that affect their exposure are discussed. There are wide variations in the radiation dose (up to 1000-fold) per procedure. Despite extensive improvements in equipment and technology, there has been little or no reduction in dose over time. The wide variation and lack of reduction in operator doses strongly suggests that more attention must be paid to factors influencing the operator dose. Numerous patient, physician and shielding factors influence the operator dose to different degrees. Operators can change some of these factors immediately, at minimal or no cost, with a substantial reduction in dose and potential cancer risk.
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Affiliation(s)
- Kwang Pyo Kim
- Department of Nuclear Engineering, Kyung Hee University, 1 Seocheon-dong, Giheung-gu, Yongin-si, Gyeonggi-do, Republic of Korea.
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Pantos I, Patatoukas G, Katritsis DG, Efstathopoulos E. Patient radiation doses in interventional cardiology procedures. Curr Cardiol Rev 2009; 5:1-11. [PMID: 20066141 PMCID: PMC2803281 DOI: 10.2174/157340309787048059] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/01/2008] [Accepted: 08/01/2008] [Indexed: 11/22/2022] Open
Abstract
Interventional cardiology procedures result in substantial patient radiation doses due to prolonged fluoroscopy time and radiographic exposure. The procedures that are most frequently performed are coronary angiography, percutaneous coronary interventions, diagnostic electrophysiology studies and radiofrequency catheter ablation. Patient radiation dose in these procedures can be assessed either by measurements on a series of patients in real clinical practice or measurements using patient-equivalent phantoms. In this article we review the derived doses at non-pediatric patients from 72 relevant studies published during the last 22 years in international scientific literature. Published results indicate that patient radiation doses vary widely among the different interventional cardiology procedures but also among equivalent studies. Discrepancies of the derived results are patient-, procedure-, physician-, and fluoroscopic equipmentrelated. Nevertheless, interventional cardiology procedures can subject patients to considerable radiation doses. Efforts to minimize patient exposure should always be undertaken.
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Affiliation(s)
- Ioannis Pantos
- Department of Cardiology, Athens Euroclinic, Athens, Greece
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
| | - Georgios Patatoukas
- 2 Department of Radiology, Medical Physics Unit, University of Athens, Athens, Greece
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Venneri L, Rossi F, Botto N, Andreassi MG, Salcone N, Emad A, Lazzeri M, Gori C, Vano E, Picano E. Cancer risk from professional exposure in staff working in cardiac catheterization laboratory: insights from the National Research Council's Biological Effects of Ionizing Radiation VII Report. Am Heart J 2009; 157:118-24. [PMID: 19081407 DOI: 10.1016/j.ahj.2008.08.009] [Citation(s) in RCA: 223] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Accepted: 08/08/2008] [Indexed: 11/18/2022]
Abstract
BACKGROUND Occupational doses from fluoroscopy-guided interventional procedures are the highest ones registered among medical staff using x-rays. The aim of the present study was to evaluate the order of magnitude of cancer risk caused by professional radiation exposure in modern invasive cardiology practice. METHODS From the dosimetric Tuscany Health Physics data bank of 2006, we selected dosimetric data of the 26 (7 women, 19 men; age 46 +/- 9 years) workers of the cardiovascular catheterization laboratory with effective dose >2 mSv. Effective dose (E) was expressed in milliSievert, calculated from personal dose equivalent registered by the thermoluminescent dosimeter, at waist or chest, under the apron, according to the recommendations of National Council of Radiation Protection. Lifetime attributable risk of cancer was estimated using the approach of Biological Effects of Ionizing Radiation 2006 report VII. RESULTS Cardiac catheterization laboratory staff represented 67% of the 6 workers with yearly exposure >6 mSv. Of the 26 workers with 2006 exposure >2 mSv, 15 of them had complete records of at least 10 (up to 25) consecutive years. For these 15 subjects having a more complete lifetime dosimetric history, the median individual effective dose was 46 mSv (interquartile range = 24-64). The median risk of (fatal and nonfatal) cancer (Biological Effects of Ionizing Radiation 2006) was 1 in 192 (interquartile range = 1 in 137-1 in 370). CONCLUSIONS Cumulative professional radiological exposure is associated with a non-negligible Lifetime attributable risk of cancer for the most exposed contemporary cardiac catheterization laboratory staff.
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Affiliation(s)
- Lucia Venneri
- CNR, Institute of Clinical Physiology and Fondazione Gabriele Monasterio, Pisa, Italy
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TSAPAKI V, MANIATIS PN, MAGGINAS A, VOUDRIS V, PATSILINAKOS S, VRANZTA T, VANO E, COKKINOS DS. What are the clinical and technical factors that influence the kerma–area product in percutaneous coronary intervention? Br J Radiol 2008; 81:940-5. [DOI: 10.1259/bjr/30604628] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Patient Dose Reference Levels for Interventional Radiology: A National Approach. Cardiovasc Intervent Radiol 2008; 32:19-24. [DOI: 10.1007/s00270-008-9439-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 08/05/2008] [Accepted: 09/03/2008] [Indexed: 11/26/2022]
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Vano E, Gonzalez L, Fernández JM, Haskal ZJ. Eye lens exposure to radiation in interventional suites: caution is warranted. Radiology 2008; 248:945-53. [PMID: 18632529 DOI: 10.1148/radiol.2482071800] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To report estimated radiation doses to the eye lens of the interventionalist from procedures performed with and without use of radiation protection measures. MATERIALS AND METHODS Scattered radiation doses for seven interventional radiology fluoroscopic systems were measured by using phantoms simulating patients 16-28 cm in thickness undergoing low-, medium-, and high-mode fluoroscopy, cine cardiac imaging, and digital subtraction angiography (DSA). The radiation doses to the eye lens in low- and high-dose scenarios were estimated. Beam angulation, biplanar equipment, working distance, procedure complexity, imaging collimation, and use of eyeglasses and/or protective suspended screens were taken into account. The doses to the lens in several procedures were assessed. RESULTS Mean scattered radiation doses to the lens during fluoroscopy were 6.0 and 34.5 microSv/min in the low- and high-dose scenarios, respectively. For DSA, typical doses to the lens ranged from 0.77 to 3.33 microSv per image. Operation modes involving increasing or decreasing radiation doses were quantified. For hepatic chemoembolization, iliac angioplasty, pelvic embolization, and transjugular intrahepatic portosystemic shunt creation, lens doses ranged from 0.25 to 3.72 mSv per procedure when protection was not used. Lens doses in the neuroembolization procedures could exceed 10 mSv per procedure. CONCLUSION With typical reported workloads, radiation doses to eye lenses may exceed the threshold for deterministic effects (ie, lens opacities or cataracts) after several years of work if radiation protection tools are not used.
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Affiliation(s)
- Eliseo Vano
- Department of Radiology, Complutense University, 28040 Madrid, Spain.
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D'Helft C, McGee A, Rainford L, McFadden S, Winder J, Hughes C, Brennan PC. Proposed preliminary diagnostic reference levels for three common interventional cardiology procedures in Ireland. RADIATION PROTECTION DOSIMETRY 2008; 129:63-66. [PMID: 18420567 DOI: 10.1093/rpd/ncn048] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
This study has gathered data across Ireland to determine the range of radiation doses received during interventional cardiology (IC) investigations. Radiation doses for three common types of IC examinations where investigated: coronary angiography (CA), percutaneous coronary intervention (PCI) and pacemaker insertions (PPI). A total of 22 cardiac imaging suites participated in the study. Radiation dose was monitored for 1804 adult patients using dose area product (DAP) meters. Individual patient DAP values ranged from 136-23,101 cGy cm2, 475-41,038 cGy cm2 and 45-17,192 cGy cm2 for CA, PCI and PPI respectively, with third quartile values of 4654 cGy cm2, 10,650 cGy cm2 and 1686 cGy cm2. The importance of optimising radiation dose, while not compromising diagnostic efficacy is clear. Although setting reference levels for these complex procedures has some difficulties, it is important that some guideline values are available as a benchmark to guide the operators during these potentially high dose procedures. The third quartile values as described by this paper may offer such guidance.
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Affiliation(s)
- C D'Helft
- Diagnostic Imaging, Health Sciences, University College Dublin, Belfield, Dublin 4, Ireland, UK.
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Roghi A, Savonitto S, Cavallini C, Arraiz G, Angoli L, Castriota F, Bernardi G, Sansa M, De Servi S, Pitscheider W, Danzi GB, Reimers B, Klugmann S, Zaninotto M, Ardissino D. Impact of acute renal failure following percutaneous coronary intervention on long-term mortality. J Cardiovasc Med (Hagerstown) 2008; 9:375-81. [DOI: 10.2459/jcm.0b013e3282eee979] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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50
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Kim KP, Miller DL, Balter S, Kleinerman RA, Linet MS, Kwon D, Simon SL. Occupational radiation doses to operators performing cardiac catheterization procedures. HEALTH PHYSICS 2008; 94:211-227. [PMID: 18301095 DOI: 10.1097/01.hp.0000290614.76386.35] [Citation(s) in RCA: 196] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cardiac catheterization procedures using fluoroscopy reduce patient morbidity and mortality compared to operative procedures. These diagnostic and therapeutic procedures require radiation exposure to patients and physicians. The objectives of the present investigation were to provide a systematic comprehensive summary of the reported radiation doses received by operators due to diagnostic or interventional fluoroscopically-guided procedures, to identify the primary factors influencing operator radiation dose, and to evaluate whether there have been temporal changes in the radiation doses received by operators performing these procedures. Using PubMed, we identified all English-language journal articles and other published data reporting radiation exposures to operators from diagnostic or interventional fluoroscopically-guided cardiovascular procedures from the early 1970's through the present. We abstracted the reported radiation doses, dose measurement methods, fluoroscopy system used, operational features, radiation protection features, and other relevant data. We calculated effective doses to operators in each study to facilitate comparisons. The effective doses ranged from 0.02-38.0 microSv for DC (diagnostic catheterizations), 0.17-31.2 microSv for PCI (percutaneous coronary interventions), 0.24-9.6 microSv for ablations, and 0.29-17.4 microSv for pacemaker or intracardiac defibrillator implantations. The ratios of doses between various anatomic sites and the thyroid, measured over protective shields, were 0.9 +/- 1.0 for the eye, 1.0 +/- 1.5 for the trunk, and 1.3 +/- 2.0 for the hand. Generally, radiation dose is higher on the left side of an operator's body, because the operator's left side is closer to the primary beam when standing at the patient's right side. Modest operator dose reductions over time were observed for DC and ablation, primarily due to reduction in patient doses due to decreased fluoroscopy/cineradiography time and dose rate by technology improvement. Doses were not reduced over time for PCI. The increased complexity of medical procedures appears to have offset dose reductions due to improvements in technology. The large variation in operator doses observed for the same type of procedure suggests that optimizing procedure protocols and implementing general use of the most effective types of protective devices and shields may reduce occupational radiation doses to operators. We had considerable difficulty in comparing reported dosimetry results because of significant differences in dosimetric methods used in each study and multiple factors influencing the actual doses received. Better standardization of dosimetric methods will facilitate future analyses aimed at determining how well medical radiation workers are being protected.
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Affiliation(s)
- Kwang Pyo Kim
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892-7238, USA.
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